1
|
Niriayo YL, Kifle R, Asgedom SW, Gidey K. Drug therapy problems among hospitalized patients with cardiovascular disease. BMC Cardiovasc Disord 2024; 24:50. [PMID: 38221638 PMCID: PMC10788969 DOI: 10.1186/s12872-024-03710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Optimal utilization of cardiovascular drugs is crucial in reducing morbidity and mortality associated with cardiovascular diseases. However, the effectiveness of these drugs can be compromised by drug therapy problems. Hospitalized patients with cardiovascular diseases, particularly those with multiple comorbidities, polypharmacy, and advanced age, are more susceptible to experiencing drug therapy problems. However, little is known about drug therapy problems and their contributing factors among patients with cardiovascular disease in our setting. Therefore, our study aimed to investigate drug therapy problems and their contributing factors in patients with cardiovascular diseases. METHOD A prospective observational study was conducted among hospitalized patients with cardiovascular disease at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia from December 2020 to May 2021. We collected the data through patient interviews and review of patients' medical records. We employed Cipolle's method to identify and categorize drug therapy problems and sought consensus from a panel of experts through review. Data analysis was performed using the Statistical Software Package SPSS version 22. Binary logistic regression analysis was performed to determine the contributing factors of drug therapy problems in patients with cardiovascular disease. Statistical significance was set at p < 0.05. RESULTS The study included a total of 222 patients, of whom 117 (52.7%) experienced one or more drug-related problems. We identified 177 drug therapy problems equating to 1.4 ± 0.7 drug therapy problems per patients. The most frequently identified DTP was the need for additional drug therapy (32.4%), followed by ineffective drug therapy (14%), and unnecessary drug therapy (13.1%). The predicting factors for drug therapy problems were old age (AOR: 3.97, 95%CI: 1.68-9.36) and number of medications ≥ 5 (AOR: 2.68, 95%CI: 1.47-5.11). CONCLUSION More than half of the patients experienced drug therapy problems in our study. Old age and number of medications were the predicting factors of drug therapy problems. Therefore, greater attention and focus should be given to patients who are at risk of developing drug therapy problems.
Collapse
Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
| | - Roba Kifle
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| |
Collapse
|
2
|
Kitaw TA, Haile RN. Prevalence of polypharmacy among older adults in Ethiopia: a systematic review and meta-analysis. Sci Rep 2023; 13:17641. [PMID: 37848565 PMCID: PMC10582100 DOI: 10.1038/s41598-023-45095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 10/16/2023] [Indexed: 10/19/2023] Open
Abstract
Polypharmacy is a significant concern for older adults. Taking multiple medicines to prevent and treat comorbidities is very common in older adults, potentially leading to polypharmacy. Polypharmacy is associated with the development of geriatric syndromes, including cognitive impairment, delirium, falls, frailty, urinary incontinence, and weight loss. The prevalence of polypharmacy varies according to the literature. There is a paucity of data regarding the prevalence of polypharmacy among older adults. Therefore, this study aimed to estimate the pooled prevalence of polypharmacy among older adults in Ethiopia. A comprehensive search of databases, including PubMed, MEDLINE, EMBASE, Hinari, Cumulative Index to Nursing and Allied Health Literature, International Scientific Indexing, Cochrane library and Web of Science, and Google Scholar, was conducted. STATA statistical software (version 17) was used to analyze the data. Forest plot and I2 heterogeneity test were computed to examine the existence of heterogeneity. Subgroup analysis and sensitivity analysis were done to explore the source of heterogeneity. Publication bias was evaluated by using funnel plots and Egger's test. A random effect model was used to determine the pooled prevalence of polypharmacy. After reviewing 123 studies, 13 studies with a total of 3547 older adults fulfilled the inclusion criteria and were included in this meta-analysis. The result from 13 studies revealed that the pooled prevalence of polypharmacy among older adults in Ethiopia was 37.10% (95CI: 28.28-45.91). A Subgroup Meta-analysis showed that the heterogeneity level was slightly lower among studies done in Oromia region (I2 = 46.62, P-value = 0.154). Higher pooled polypharmacy prevalence was found among older adults with cardiovascular disorders (42.7%) and admitted patients (51.4%). In general, it was found that the pooled prevalence of polypharmacy among older adults in Ethiopia was high. More than one in three older adults take five or more medications at a time. Thus, intervention focusing on rational geriatric pharmacotherapy is significant to prevent unnecessary pill burden, adverse drug events, medical costs, geriatric morbidity, and mortality. Furthermore, enhancing pharmacist roles towards medication therapy management and safety monitoring in older adults is also indicated.
Collapse
Affiliation(s)
- Tegene Atamenta Kitaw
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia.
| | - Ribka Nigatu Haile
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| |
Collapse
|
3
|
Anfinogenova ND, Novikova OM, Trubacheva IA, Efimova EV, Chesalov NP, Ussov WY, Maksimova AS, Shelkovnikova TA, Ryumshina NI, Stepanov VA, Popov SV, Repin AN. Prescribed Versus Taken Polypharmacy and Drug-Drug Interactions in Older Cardiovascular Patients during the COVID-19 Pandemic: Observational Cross-Sectional Analytical Study. J Clin Med 2023; 12:5061. [PMID: 37568464 PMCID: PMC10420276 DOI: 10.3390/jcm12155061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
The study aimed to assess clinical pharmacology patterns of prescribed and taken medications in older cardiovascular patients using electronic health records (EHRs) (n = 704) (2019-2022). Medscape Drug Interaction Checker was used to identify pairwise drug-drug interactions (DDIs). Prevalence rates of DDIs were 73.5% and 68.5% among taken and prescribed drugs, respectively. However, the total number of DDIs was significantly higher among the prescribed medications (p < 0.05). Serious DDIs comprised 16% and 7% of all DDIs among the prescribed and taken medications, respectively (p < 0.05). Median numbers of DDIs between the prescribed vs. taken medications were Me = 2, IQR 0-7 vs. Me = 3, IQR 0-7 per record, respectively. Prevalence of polypharmacy was significantly higher among the prescribed medications compared with that among the taken drugs (p < 0.05). Women were taking significantly more drugs and had higher prevalence of polypharmacy and DDIs (p < 0.05). No sex-related differences were observed in the list of prescribed medications. ICD code U07.1 (COVID-19, virus identified) was associated with the highest median DDI number per record. Further research is warranted to improve EHR structure, implement patient engagement in reporting adverse drug reactions, and provide genetic profiling of patients to avoid potentially serious DDIs.
Collapse
Affiliation(s)
- Nina D. Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
| | - Oksana M. Novikova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
| | - Irina A. Trubacheva
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
| | - Elena V. Efimova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
| | - Nazary P. Chesalov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
| | - Wladimir Y. Ussov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
- Meshalkin National Medical Research Center, Novosibirsk 630055, Russia
| | - Aleksandra S. Maksimova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
| | - Tatiana A. Shelkovnikova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
| | - Nadezhda I. Ryumshina
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
| | - Vadim A. Stepanov
- Research Institute of Medical Genetics, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634050, Russia;
| | - Sergey V. Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
| | - Alexey N. Repin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (O.M.N.); (I.A.T.); (E.V.E.); (N.P.C.); (W.Y.U.); (A.S.M.); (T.A.S.); (N.I.R.); (S.V.P.); (A.N.R.)
| |
Collapse
|
4
|
Alhumaidi RM, Bamagous GA, Alsanosi SM, Alqashqari HS, Qadhi RS, Alhindi YZ, Ayoub N, Falemban AH. Risk of Polypharmacy and Its Outcome in Terms of Drug Interaction in an Elderly Population: A Retrospective Cross-Sectional Study. J Clin Med 2023; 12:3960. [PMID: 37373654 DOI: 10.3390/jcm12123960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/24/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
The simultaneous use of multiple drugs-termed 'polypharmacy'-is often required to manage multiple physiological and biological changes and the interplay between chronic disorders that are expected to increase in association with ageing. However, by increasing the number of medications consumed, the risk of undesirable medication reactions and drug interactions also increases exponentially. Hence, knowledge of the prevalence of polypharmacy and the risk of potentially serious drug-drug interactions (DDIs) in elderly patients should be considered a key topic of interest for public health and health care professionals. Methods: Prescription and demographic data were collected from the electronic files of patients who were aged ≥ 65 years and attended Al-Noor Hospital in Makkah, Saudi Arabia, between 2015 and 2022. The Lexicomp® electronic DDI-checking platform was used to evaluate the patients' medication regimens for any potential drug interactions. Results: A total of 259 patients were included in the study. The prevalence of polypharmacy among the cohort was 97.2%: 16 (6.2%) had minor polypharmacy, 35 (13.5%) had moderate polypharmacy, and 201 (77.6%) had major polypharmacy. Of the 259 patients who were taking two or more medications simultaneously, 221 (85.3%) had at least one potential DDI (pDDI). The most frequently reported pDDI under category X that should be avoided was the interaction between clopidogrel and esomeprazole and was found in 23 patients (18%). The most frequently reported pDDI under category D that required therapeutic modification was the interaction between enoxaparin and aspirin, which was found in 28 patients (12%). Conclusions: It is often necessary for elderly patients to take several medications simultaneously to manage chronic diseases. Clinicians should distinguish between suitable, appropriate and unsuitable, inappropriate polypharmacy, and this criterion should be closely examined when establishing a therapeutic plan.
Collapse
Affiliation(s)
- Reham M Alhumaidi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Ghazi A Bamagous
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Safaa M Alsanosi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Hamsah S Alqashqari
- Department of Community Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Rawabi S Qadhi
- Institute of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8QQ, UK
| | - Yosra Z Alhindi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Nahla Ayoub
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Alaa H Falemban
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| |
Collapse
|
5
|
Adem L, Tegegne GT. Medication Appropriateness, Polypharmacy, and Drug-Drug Interactions in Ambulatory Elderly Patients with Cardiovascular Diseases at Tikur Anbessa Specialized Hospital, Ethiopia. Clin Interv Aging 2022; 17:509-517. [PMID: 35464156 PMCID: PMC9020506 DOI: 10.2147/cia.s358633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Objective Methods Results Conclusion
Collapse
Affiliation(s)
- Limi Adem
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gobezie T Tegegne
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Gobezie T Tegegne, Email
| |
Collapse
|
6
|
Dagnew SB, Tadesse TY, Zeleke MM, Yiblet TG, Addis GT, Mekonnen GB, Agegnew Wondm S, Negash EA. Drug–drug interactions among hospitalized elderly in patients at medical wards of Northwest Ethiopia’s Comprehensive Specialized Hospitals: A multicenter observational study. SAGE Open Med 2022; 10:20503121221135874. [PMID: 36385798 PMCID: PMC9647268 DOI: 10.1177/20503121221135874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Objective: Drug–drug interactions are of major concern due to links to untoward drug
effects, hospitalizations, and serious health impacts. Elderly patients are
more predisposed to drug interactions than younger patients. The present
study aimed to find out the prevalence of drug–drug interactions at North
West Ethiopian compressive specialized hospitals’ Internal Medicine
wards. Methods: From 30 April to 30 July 2021 GC, a multicenter prospective observational
study was conducted at north Ethiopian specialized hospitals. Data was
collected by using a structured questionnaire adapted from different
literature and medical records at the North West Ethiopian Comprehensive
Specialized Hospitals’ Internal Medicine wards during the study period.
Thereafter checked the completeness of the collected data was checked
drug–drug interactions by using Medscape. Epi data version 4.6.2 software
was used as data clearance and STATA version 14.1 was used for further data
analysis. Result: A total of 389 subjects participated in the study of which more than half
(55.53%) of them were female with a mean (SD) age of 68.9 ± 7.46 years. A
total of 641 drug–drug interactions were detected in this investigation of
which, 225(35.1%) were major, 299(46.6%) were significant interactions, and
117(18.3%) were minor interactions. Hospital stay (AOR = 5.95 CI:
3.49–10.12), retire (AOR = 6.71 CI: 1.26–35.78), 5–9 drugs (AOR = 5.30 CI:
2.91–9.67) and more than 10 drugs (AOR = 8.03 CI: 2.47–26.07) were important
risk factors for drug–drug interactions. Conclusion: The findings of this study suggest that drug–drug interactions were high
among hospitalized elderly patients. The presence of polypharmacy, to be
retired, and hospital stayed were all found to be strongly linked with
drug–drug interactions.
Collapse
Affiliation(s)
- Samuel Berihun Dagnew
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tesfaye Yimer Tadesse
- Pharmacology and Toxicology Unit, School of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Molla Zeleke
- Pharmacology and Toxicology Unit, School of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tesfagegn Gobezie Yiblet
- Pharmacology and Toxicology Unit, School of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getu Tesfaw Addis
- Social and Administrative Pharmacy Unit, School of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Binega Mekonnen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samuel Agegnew Wondm
- Clinical Pharmacy Unit, School of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Erkihun Assefa Negash
- Clinical Pharmacy Unit, School of Pharmacy, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia
| |
Collapse
|
7
|
Okoro RN, Idris AI. Older adults’ exposure to anticholinergic medications: Implications for pharmaceutical care for Nigerian older adults. THE JOURNAL OF MEDICINE ACCESS 2022; 6:27550834221112753. [PMID: 36204529 PMCID: PMC9483949 DOI: 10.1177/27550834221112753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/22/2022] [Indexed: 11/15/2022]
Abstract
Introduction: Anticholinergic medications which are commonly prescribed to older adults can
produce more pronounced adverse effects compared to the younger
population. Objectives: To investigate the prevalence of polypharmacy, describe the prescription
patterns of anticholinergic medications, determine the prevalence of
exposure to high-risk anticholinergic cognitive burden (ACB) medications,
and identify the potential predictors of exposure to high-risk ACB
medications in older adults in a Nigerian secondary hospital. Methods: This cross-sectional study that included older adults prescribed at least one
anticholinergic medication was conducted at a secondary care hospital in
Nigeria. The study data were initially summarized using descriptive
statistics, whereas multivariable logistic regression analysis was used to
identify the potential predictors of exposure to high-risk ACB medications.
In this study, the cumulative ACB scores were dichotomized into low risk
(score 1–2) and high risk (score ⩾ 3). A p value less than
0.05 was considered to be statistically significant. Results: A total of 256 older adults were included in this study; 113 (44.1%) had
polypharmacy, whereas 26.6% (188/256) were exposed to high-risk ACB
medications. Of a total of 391 anticholinergic medications used by the
population, furosemide (36.57%) was the most commonly prescribed. The
adjusted multivariable logistic regression analysis indicated that patients
who had acute diseases were 2.5 times (adjusted odds ratio (AOR) = 2.49, 95%
confidence interval (CI): 1.40–4.45) more likely to be exposed to high-risk
ACB medications than those with chronic diseases. Conclusion: The study demonstrates a high prevalence of polypharmacy and exposure to
high-risk ACB medications suggesting the need for pharmaceutical care in
this high-risk population. Older adults’ exposure to high-risk ACB
medications was significantly associated with prescriptions for acute
diseases.
Collapse
Affiliation(s)
- Roland Nnaemeka Okoro
- Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, Maiduguri, Nigeria
| | - Algoni Idris Idris
- Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, Maiduguri, Nigeria
| |
Collapse
|
8
|
Georgiev KD, Hvarchanova N, Stoychev E, Kanazirev B. Prevalence of polypharmacy and risk of potential drug-drug interactions among hospitalized patients with emphasis on the pharmacokinetics. Sci Prog 2022; 105:368504211070183. [PMID: 35072561 PMCID: PMC10358706 DOI: 10.1177/00368504211070183] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Both polypharmacy and potential drug-drug interactions (pDDIs), especially those at the pharmacokinetic level, are common in hospitalized patients and are associated with adverse effects and failure of therapy. OBJECTIVE The aim of the present study is to investigate retrospectively the prevalence of polypharmacy and the risk of potential pharmacokinetic drug-drug interaction among hospitalized patients. METHODS The medical documentation of hospitalized patients in the unit of internal diseases at the hospital "St Marina" in Varna, Bulgaria for a period of six months (January-July 2016) was retrospectively reviewed. Lexicomp® Drug Interaction software was used for the detection of pDDI. Descriptive statistic and logistic regression were used for data analysis. RESULTS In this study, 294 patients out of 510 (57%) were selected with polypharmacy. The number of detected potential pharmacokinetic DDIs (pPKDDIs) was only 216 (or 12,4%), but almost 40% of patients with polypharmacy were exposed to at least one pPKDDIs. The most common pPKDDIs occur at the biotransformation level - 78 (36,1%), and the most common enzyme form that is involved in these interactions is cytochrome 3A4 (44 or 20,4%). The number of prescribed medications (>7) was found to increase the possibility of having pDDIs (OR 25.535, 95% CI 12.529 to 52.042; p = <0.001) and pPKDDIs (OR 5.165, 95% CI 3.430 to 7.779; p = <0.001) as well. CONCLUSION AND RELEVANCE Caution should be taken in patients taking more than seven drugs and careful assessment of the pPKDDIs should be made. When such interactions are detected, they need to be properly evaluated and managed.
Collapse
Affiliation(s)
- Kaloyan D. Georgiev
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
| | - Nadezhda Hvarchanova
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
| | - Elitsa Stoychev
- Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
| | - Branimir Kanazirev
- Department of Internal Medicine, UMHAT “St Marina”, Faculty of Medicine, Medical University “Prof. Dr Paraskev Stoyanov”, Varna, Bulgaria
| |
Collapse
|
9
|
Ali I, Bazzar A, Hussein N, Sahhar E. Potential drug-drug interactions in ICU patients: a retrospective study. Drug Metab Pers Ther 2020; 35:dmpt-2020-0114. [PMID: 32681774 DOI: 10.1515/dmpt-2020-0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/29/2020] [Indexed: 12/26/2022]
Abstract
Objectives A "potential drug-drug interaction" (pDDI) is the possibility one drug has to alter the effects of another when both are administered simultaneously. Intensive care unit (ICU) patients are especially prone to these pDDIs. This study aimed to determine the frequency and severity of pDDIs during the hospitalization of patients in the ICU. Methods This study was conducted retrospectively in three hospitals, including both governmental and non-governmental hospitals in Nablus, Palestine, over the course of six months; starting in January 2018 and ending in June 2018. The sample size included 232 ICU patients, and medications prescribed during the hospitalization of these patients were evaluated for pDDIs using the drugs.com application. Results A total of 167 patients (72%) were found to have at least one pDDI, while the total number of pDDIs in the study was 422, resulting in an average of 1.82 pDDIs per patient. Out of the total identified pDDIs, 41 interactions (9.7%) were major interactions, 281 (66.6%) were moderate interactions and 100 (23.7%) were minor interactions. The past medical history of these patients showed that many had hypertension (29%), diabetes mellitus (25%) and ischemic heart disease (10%). A serious combination, enoxaparin and aspirin, was found in six patients. Furthermore, as the number of administered drugs increased, the number of interactions increased as well. Conclusions The pDDIs are common in ICU patients. The most common and clinically most important pDDIs require special attention. Polypharmacy significantly increases the number and level of pDDIs, especially in patients with multiple chronic illnesses. Adequate knowledge regarding the most common pDDIs is necessary to enable healthcare professionals to implement ICU strategies that ensure patient safety.
Collapse
Affiliation(s)
- Iyad Ali
- Department of Biochemistry, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Alaa Bazzar
- Department of Human Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nadine Hussein
- Department of Human Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Emile Sahhar
- Department of Human Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| |
Collapse
|